Hughes J R, Stead L F, Lancaster T
Department of Psychiatry, University of Vermont, 38 Fletcher Place, Burlington, Vermont 05401-1419, USA.
Cochrane Database Syst Rev. 2000(2):CD000031. doi: 10.1002/14651858.CD000031.
There are two reasons to believe antidepressants and anxiolytics might help in smoking. First, anxiety and depression are symptoms of nicotine withdrawal, and smoking cessation sometimes precipitates depression. Second, smoking appears to be due, in part, to deficits in dopamine, serotonin and norepinephrine, all of which are increased by anxiolytics and antidepressants.
The aim of this review is to assess the effectiveness of such drugs in aiding long term smoking cessation. The drugs include bupropion; buspirone; diazepam; doxepin; fluoxetine; imipramine; meprobamate; moclobemide; nortriptyline; tryptophan; ondansetron; venlafaxine and the beta-blockers metoprolol, oxprenolol and propanolol.
We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in Medline, Embase, SciSearch and PsycLit, and meetings abstracts.
We considered randomized trials comparing anxiolytic or antidepressant drugs to placebo or an alternative therapeutic control for smoking cessation. We excluded trials with less than 6 months follow-up.
We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model.
There was one trial each of the anxiolytics diazepam, meprobamate, metoprolol and oxprenolol. There were two trials of the anxiolytic buspirone. None of these showed evidence of effectiveness in helping smokers to quit. There was one trial each of the antidepressants fluoxetine and moclobemide, two of nortriptyline, and four trials of bupropion. Nortriptyline and bupropion increased cessation and other antidepressants might also be effective. One trial found combined bupropion and nicotine patch produced higher quit rates than patch alone.
REVIEWER'S CONCLUSIONS: There is little evidence that anxiolytics aid smoking cessation. Some antidepressants (bupropion and nortriptyline) can aid smoking cessation. It is not clear whether these effects are specific for individual drugs, or a class effect.
有两个理由相信抗抑郁药和抗焦虑药可能有助于戒烟。其一，焦虑和抑郁是尼古丁戒断的症状，而且戒烟有时会引发抑郁。其二，吸烟似乎部分归因于多巴胺、血清素和去甲肾上腺素的缺乏，而抗焦虑药和抗抑郁药都会增加这些物质的含量。
本综述的目的是评估此类药物在辅助长期戒烟方面的有效性。这些药物包括安非他酮；丁螺环酮；地西泮；多塞平；氟西汀；丙咪嗪；甲丙氨酯；吗氯贝胺；去甲替林；色氨酸；昂丹司琼；文拉法辛以及β受体阻滞剂美托洛尔、氧烯洛尔和普萘洛尔。
我们检索了Cochrane烟草成瘾小组试验注册库，其中包括在Medline、Embase、SciSearch和PsycLit中索引的试验以及会议摘要。
我们纳入了比较抗焦虑药或抗抑郁药与安慰剂或戒烟替代治疗对照的随机试验。我们排除了随访时间少于6个月的试验。
我们对研究人群类型、药物治疗性质、结局指标、随机化方法和随访完整性进行了重复数据提取。主要结局指标是基线吸烟的患者在至少6个月随访后戒烟情况。我们对每个试验采用了最严格的戒烟定义，如有可用数据则采用生化验证率。在适当情况下，我们使用固定效应模型进行荟萃分析。
抗焦虑药地西泮、甲丙氨酯、美托洛尔和氧烯洛尔各有一项试验。抗焦虑药丁螺环酮有两项试验。这些试验均未显示出有助于吸烟者戒烟的有效性证据。抗抑郁药氟西汀和吗氯贝胺各有一项试验，去甲替林有两项试验，安非他酮有四项试验。去甲替林和安非他酮可提高戒烟率，其他抗抑郁药可能也有效。一项试验发现，安非他酮与尼古丁贴片联合使用比单独使用贴片产生的戒烟率更高。
几乎没有证据表明抗焦虑药有助于戒烟。一些抗抑郁药（安非他酮和去甲替林）可以辅助戒烟。目前尚不清楚这些效果是个别药物特有的，还是一类药物的共同作用。
